{
"Npi": {
"NPI": "1477614741",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "LEMUEL C & ELMEZEN MARTIN",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 1560",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LAKEPORT",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "95453-1560",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "707-263-6845",
"MailingAddressFaxNumber": "707-263-6451",
"FirstLinePracticeLocationAddress": "422 LAKEPORT BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKEPORT",
"PracticeLocationAddressStateName": "CA",
"PracticeLocationAddressPostalCode": "95453-5404",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "707-263-6845",
"PracticeLocationAddressFaxNumber": "707-263-6451",
"EnumerationDate": "12/12/2006",
"LastUpdateDate": "07/16/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MARTIN",
"AuthorizedOfficialFirstName": "LEMUEL",
"AuthorizedOfficialMiddleName": "CAMPOMANES",
"AuthorizedOfficialTitle": "PHYSICAL THERAPIST OWNER",
"AuthorizedOfficialNamePrefix": "MR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PT",
"AuthorizedOfficialTelephoneNumber": "707-263-6845",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "225100000X",
"TaxonomyName": "Physical Therapist",
"LicenseNumber": "PT11399",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}